Provider Demographics
NPI:1326403130
Name:INFECTIOUS DISEASE ASSOCIATES OF ORANGE COUNTY, INC.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATES OF ORANGE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:TA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-664-0045
Mailing Address - Street 1:2321 E 4TH STREET
Mailing Address - Street 2:SUITE C #637
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3606
Mailing Address - Country:US
Mailing Address - Phone:714-664-0045
Mailing Address - Fax:714-664-0049
Practice Address - Street 1:999 N TUSTIN AVE STE 109
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6501
Practice Address - Country:US
Practice Address - Phone:714-664-0045
Practice Address - Fax:714-664-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326403130Medicaid